Healthcare Provider Details

I. General information

NPI: 1962228239
Provider Name (Legal Business Name): SWATHI KESHAVA REDDY MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE DEPT OF PEDIATRICS
ALBANY NY
12208
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE DEPT OF PEDIATRICS
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 516-262-5588
  • Fax: 518-262-5589
Mailing address:
  • Phone: 516-262-5588
  • Fax: 518-262-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number65039
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: